‘In war-torn Syria, my enemy’s doctor is my enemy’

Syrian girls and their father, injured during violence in their country, are seen after undergoing multiple reconstructive surgeries at the Red Crescent Hospital in Amman July 3, 2012 (Reuters/Ali Jarekji) / Reuters

What do the Syrian opposition, a jihadist group, a Gulf State, Iran and the US have in common?All provide ‘humanitarian’ aid to the side they support in the conflict, none can curb the suffering alone, or ensure that aid reaches the most vulnerable first.

This is not a simple war, and there are no simple aid solutions,
but the status quo cannot be an option. The political complexity of
the crisis is mirrored in the humanitarian response; the majority
of aid to Syria is perceived to be on one side or the other. It is
virtually impossible for aid to cross multiple frontlines at the
scale required to meet the immense needs. At present aid
organisations are generally reliant on crossing the border
illegally into areas controlled by the opposition and having aid
delivered with the help of opposition networks.

This is a challenge because the provider of aid becomes painted
with a brush of political solidarity with one side or the other –
and all aid becomes contested. Attempting to cross the frontlines
of this conflict without the willingness of all parties means that
you can be turned back at checkpoints as someone who has been
assisting ‘the enemy’ or have to run the gauntlet of bombardment
and snipers. But for aid to reach places like Homs, Deraa and the
suburbs of Damascus, it has to be able to cross frontlines. An aid
convoy from Damascus was recently turned back when it reached an
opposition controlled area because the providers of aid were not
trusted.

Millions of people face severe shortages of food, fuel, shelter
and clean water. There are now 1-million refugees that have fled
the country and 2.5 million people displaced within Syria. Entire
communities live in indescribable fear, under siege and constant
shelling. Recently, there have been reported outbreaks in
opposition controlled areas of typhoid and leishmaniasis. Médecins
Sans Frontières/Doctors Without Borders (MSF) was only able to
donate medical supplies, as intense fighting meant our medical
teams couldn’t reach these areas.

The destruction of health facilities has left a medical void.
According to the Syrian authorities, 57 percent of public hospitals
in the country have been damaged and 36 percent are no longer
functional. Though for a complete picture of the devastation, the
destruction of makeshift field hospitals should also be added to
the tally.

From the start of the conflict, denial of health care and the
targeting of medical facilities and staff has been a tactic of war.
Many areas rely on makeshift field hospitals, most of which are
hasty conversions – from kitchen tables to underground basements.
Health workers have fled the conflict areas and I have even seen a
construction worker operating as a surgeon. Some of these field
hospitals priorities the treatment of fighters, leaving a gap in
health provision for the general population. There are also field
hospitals that have turned away some wounded who are perceived to
be sympathetic to a different side of the conflict.

The public health system is under huge strain. International
sanctions have frozen financial assets and transactions, making it
impossible for the government to purchase medical supplies
internationally. Syria used to produce 90% of its own medical
supplies – but most of the factories have now been destroyed. On a
recent visit to Damascus I saw that in health facilities there are
major shortages of medical supplies.

Without authorization to work from the government, MSF has
nevertheless established three unofficial hospitals in the north,
while continuing to send – and sometimes smuggle - relief and
medical supplies into both government and opposition controlled
territories. This is not the most effective way for us to
respond to the immense needs across the country. Our response
is a drop in the ocean.

The polarization of aid is perpetuated on all sides. Regional
and western powers have an interest in providing aid out of
political solidarity. The United Nations is only able to channel
aid through Damascus – and is reliant on an unlikely
security-council resolution to provide aid across borders without
the government’s agreement. The most active providers of aid in
Syria today are diaspora networks and local communities themselves,
which are the networks that have allowed MSF to develop its
humanitarian activities over the past two years.

Considering the way in which aid is delivered in Syria today,
the parties to the conflict and communities themselves have reason
to be skeptical about aid provided from areas under the control of
their opponent. This is a reality created through the denial of
access by Damascus for independent organizations – which allows
those with geo-political agendas in their provision of aid to hide
behind the excuse of having no other option but to enter Syria
illegally.

Damascus holds the key to unraveling the paralysis of the aid
response by allowing the free circulation of independent
assistance. A negotiated agreement between all parties is urgently
needed to allow life-saving aid to be delivered on the scale
required and in the most efficient way, across frontlines and
across the border. A concerted diplomatic effort is essential to
ensure that this agreement is reached immediately. Without this,
aid cannot be extracted from the geo-political complexity that has
plagued this crisis and hampered the response. Whilst we wait
for the deadlock to be broken, aid still urgently needs to be
ramped up where possible, even without the agreement of all parties
to the conflict, however imperfect this solution may be. As the
violence in Syria continues unabated, the failure of the aid
response becomes all the more unacceptable.